title: Reverse prostheses in arthropathies with cuff tear: are survivorship and function maintained over time?
abstract: BACKGROUND
  The use of reverse shoulder arthroplasty has considerably increased since first introduced in 1985. Despite demonstrating early improvement of function and pain, there is limited information regarding the durability and longer-term outcomes of this prosthesis.
  
  
  OBJECTIVE
  We determined complication rates, functional scores over time, survivorship, and whether radiographs would develop signs of loosening.
  
  
  METHODS
  We retrospectively reviewed 527 reverse shoulder arthroplasties performed in 506 patients between 1985 and 2003. Clinical and radiographic assessment was performed in 464 patients with a minimum followup of 2 years and 148 patients with a minimum followup of 5 years (mean, 7.5 years; range, 5-17 years). Cumulative survival curves were established with end points being prosthesis revision and Constant-Murley score of less than 30 points.
  
  
  RESULTS
  Eighty-nine of 489 had at least one complication for a total of 107 complications. Survivorship free of revision was 89% at 10 years with a marked break occurring at 2 and 9 years. Survivorship to a Constant-Murley score of less than 30 was 72% at 10 years with a marked break observed at 8 years. We observed progressive radiographic changes after 5 years and an increasing frequency of large notches with long-term followup.
  
  
  CONCLUSIONS
  Although the need for revision of reverse shoulder arthroplasty was relatively low at 10 years, Constant-Murley score and radiographic changes deteriorated with time. These findings are concerning regarding the longevity of the reverse shoulder arthroplasty, and therefore caution must be exercised when recommending reverse shoulder arthroplasty, especially in younger patients.
  
  
  METHODS
  Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Service Orthopedie Traumatologie, 1 CHU Trousseau, 37044 Tours Cedex, France. favard@med.univ-tours.fr
authors.forename: Luc
authors.initials: L
authors.lastname: Favard
authors.forename: Christophe
authors.initials: C
authors.lastname: Levigne
authors.forename: Cécile
authors.initials: C
authors.lastname: Nerot
authors.forename: Christian
authors.initials: C
authors.lastname: Gerber
authors.forename: Lieven
authors.initials: L
authors.lastname: De Wilde
authors.forename: Daniel
authors.initials: D
authors.lastname: Mole
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000009:adverse effects / Q000295:instrumentation*; D001696:Biomechanical Phenomena; D004185:Disability Evaluation; D005260:Female; D005602:France; D006801:Humans; D007595:Joint Prosthesis; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control; D018579:Patient Selection; D011474:Prosthesis Design; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D017006:Rotator Cuff / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D012421:Rupture; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D020069:Shoulder Pain / Q000209:etiology / Q000517:prevention & control; D013708:Tendon Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome